Impact of Project ECHO Models of Medical Tele-Education: a Systematic Review

Abstract

BACKGROUND: Extension for Community Health care Outcomes (ECHO) and related models of medical teleeducation are rapidly expanding; however, their effectiveness remains unclear. This systematic review examines the effectiveness of ECHO and ECHO-like medical teleeducation models of healthcare delivery in terms of improved provider-and patient-related outcomes. METHODS: We searched English-language studies in PubMed, Embase, and PsycINFO databases from 1 January 2007 to 1 December 2018 as well as bibliography review. Two reviewers independently screened citations for peer-reviewed publications reporting provider-and/ or patient-related outcomes of technology-enabled collaborative learning models that satisfied six criteria of the ECHO framework. Reviewers then independently abstracted data, assessed study quality, and rated strength of evidence (SOE) based on Cochrane GRADE criteria. RESULTS: Data from 52 peer-reviewed articles were included. Forty-three reported provider-related outcomes; 15 reported patient-related outcomes. Studies on provider-related outcomes suggested favorable results across three domains: satisfaction, increased knowledge, and increased clinical confidence. However, SOE was low, relying primarily on self-reports and surveys with low response rates. One randomized trial has been conducted. For patient-related outcomes, 11 of 15 studies incorporated a comparison group; none involved randomization. Four studies reported care outcomes, while 11 reported changes in care processes. Evidence suggested effectiveness at improving outcomes for patients with hepatitis C, chronic pain, dementia, and type 2 diabetes. Evidence is generally low-quality, retrospective, non-experimental, and subject to social desirability bias and low survey response rates. DISCUSSION: The number of studies examining ECHO and ECHO-like models of medical tele-education has been modest compared with the scope and scale of implementation throughout the USA and internationally. Given the potential of ECHO to broaden access to healthcare in rural, remote, and underserved communities, more studies are needed to evaluate effectiveness. This need for evidence follows similar patterns to other service delivery models in the literature.

COVID-19 and telehealth, education, and research adaptations

“…The limited evidence we do have suggests that provider related outcomes such as provider satisfaction, knowledge and confidence are favorably impacted [16,17]. Studies evaluating patient related outcomes indicate that Project Echo is most effective for the management of chronic illnesses like hepatitis C, chronic pain, or type 2 diabetes [16,17]. Moving forward, we must rigorously evaluate models like Project Echo using randomized controlled trials or big data technology to determine if such models truly improve patient and provider related outcomes while also improving access and cost.…”

“…While early evidence supporting Project Echo (and similar models) appears promising it is important to recognize that the studies to date are relatively weak as they are all retrospective, non-experimental and subject to various types of biases [17]. The limited evidence we do have suggests that provider related outcomes such as provider satisfaction, knowledge and confidence are favorably impacted [16,17]. Studies evaluating patient related outcomes indicate that Project Echo is most effective for the management of chronic illnesses like hepatitis C, chronic pain, or type 2 diabetes [16,17].…”

Development of a Managed Clinical Network for Children’s Palliative Care – A Qualitative Evaluation

“…Project ECHO) could play an important role, and evaluations of adult palliative care ECHO networks have reportedly increased staff knowledge and con dence, and improvements in clinical practice. [45][46][47] Robust evaluations of MCNs are particularly important because of the limited evidence in children's palliative care. However, in this study the cross-cutting barriers to developing the MCN highlighted in this study have impeded plans for evaluation, and other regions are likely to experience similar challenges because of the lack of standards and care pathways, and the resulting lack of agreed outcomes and robust measurement tools.…”

Development of a Managed Clinical Network for Children’s Palliative Care – A Qualitative Evaluation

“…Project ECHO) could play an important role, and evaluations of adult palliative care ECHO networks have reportedly increased staff knowledge and con dence, and improvements in clinical practice. [32][33][34] Robust evaluation of MCNs is particularly important because of the limited evidence in children's palliative care. However, in this study the cross-cutting barriers to developing the Network had impeded plans for evaluation, and other regions are likely to experience similar challenges because of the lack of standards and care pathways, and the resulting lack of agreed outcomes and robust measurement tools.…”